本文關鍵詞： 肝硬化 超聲 膽囊 肝功能　出處：《青島大學》2017年碩士論文　論文類型：學位論文

【摘要】：研究目的本研究通過對超聲測量的乙肝肝硬化患者膽囊壁厚度與腹水、“雙邊”征、生化指標、肝功能分級之間的比較分析,探討膽囊壁厚度與乙肝肝硬化患者生化指標的相關關系、腹水與膽囊壁厚度之間的關系、膽囊壁是否呈“雙邊”增厚與膽囊壁厚度之間的關系、膽囊壁厚度與肝功能分級之間的關系、膽囊厚度與腹水之間的關系、膽囊壁厚度在肝功能分級的提示意義,從而綜合評價乙肝肝硬化患者膽囊壁厚度在肝功能評估中的應用價值。研究方法選擇于我院就診以及明確診斷后于我院超聲科進行消化系統(tǒng)超聲檢查隨訪肝臟情況的151乙肝肝硬化患者納入本研究,分別收集納入研究所內的乙肝肝硬化患者超聲測量的膽囊壁厚度、超聲探查的腹水情況與超聲觀察下膽囊壁增厚是否呈“雙邊”征情況,并記錄該患者同一時期肝硬化相關的生化檢查結果,分析膽囊壁厚度與各生化指標之間的相關關系。根據(jù)肝功能Child-Pugh分級標準對納入研究的患者進行肝功能分級。分別就肝硬化患者是否有腹水、膽囊壁是否呈“雙邊”征及肝功能Child-Pugh分級進行分組比較分析,應用ROC曲線分析以上有差異組間膽囊壁厚的最佳截斷值。結果151例乙肝肝硬化患者膽囊壁厚度與總蛋白、白蛋白、前白蛋白水平呈顯著負相關(p0.001,p=0.007,p=0.001),余指標與膽囊壁厚度無明顯相關關系。有、無腹水的兩組患者之間膽囊壁厚度、總蛋白、白蛋白、前白蛋白、總膽紅素、直接膽紅素、間接膽紅素、谷草轉氨酶、總膽汁酸之間有統(tǒng)計學差異,余指標與擔保厚度無明顯相關關系;膽囊有無“雙邊”征的兩組患者之間膽囊壁厚度、總蛋白、白蛋白之間有統(tǒng)計學差異,余指標無明顯差異。肝功能分級A、B、C級三組患者之間膽囊壁厚度差異有統(tǒng)計學意義(F=11.208,p0.001),肝功能分級A級與B級、A級與C級患者間膽囊壁厚度差異有統(tǒng)計學意義(P=0.001、P0.001),肝功能分級B級與C級間沒有統(tǒng)計學差異(P=0.098)�；颊呤欠裼懈顾�,是否有“雙邊”征組間膽囊壁厚度差異有統(tǒng)計學意義,ROC曲線計算膽囊壁厚度,取得截斷值為0.59cm、0.58cm。肝功能分級A級與B+C級膽囊壁厚度做ROC曲線,取得截斷值為0.62cm。結論超聲測量乙肝肝硬化患者的膽囊壁厚度是一種簡便、安全、無創(chuàng)檢查新的手段,對乙肝肝硬化患者肝功能評估具有重要臨床價值。在臨床醫(yī)師判斷肝硬化患者病情方面有明顯意義。對于超聲醫(yī)師來說,對隨訪的肝硬化的患者檢查除了常規(guī)檢查外有了明確的側重點,使超聲檢查與臨床醫(yī)師對檢查的要求緊密結合,取得更好的隨訪效果。意義能夠更直觀的理解肝硬化產生的并發(fā)癥對身體帶來的影響,積極配合醫(yī)師采取的手段控制病情。
[Abstract]:Objective to compare and analyze the thickness of gallbladder wall and ascites, bilateral sign, biochemical index and liver function grade in patients with hepatitis B cirrhosis by ultrasonography. To explore the correlation between the thickness of gallbladder wall and biochemical indexes in patients with hepatitis B cirrhosis, the relationship between ascites and the thickness of gallbladder wall, and the relationship between bilaterally thickening of gallbladder wall and the thickness of gallbladder wall. The relationship between the thickness of the gallbladder wall and the grade of liver function, the relationship between the thickness of the gallbladder and ascites, and the significance of the thickness of the gallbladder wall in the grading of liver function. Therefore, the application value of gallbladder wall thickness in liver function evaluation in patients with hepatitis B cirrhosis was comprehensively evaluated. A total of 151 patients with hepatitis B cirrhosis were included in this study. The thickness of gallbladder wall, the ascites detected by ultrasonography and whether the gallbladder wall thickening was "bilateral" were collected from patients with cirrhosis of hepatitis B who were included in the study. The results of biochemical examination related to liver cirrhosis in the same period were recorded. To analyze the correlation between the thickness of gallbladder wall and the biochemical indexes. According to the liver function Child-Pugh classification standard, the liver function of the patients included in the study were graded. Whether the liver cirrhosis patients have ascites or not. Whether the gallbladder wall presented "bilateral" sign and Child-Pugh grade of liver function were compared and analyzed. ROC curve was used to analyze the best truncation value of gallbladder wall thickness among the above groups. Results the gallbladder wall thickness, total protein and albumin were measured in 151 patients with hepatitis B cirrhosis. The level of prealbumin was negatively correlated with the thickness of gallbladder wall. There were significant differences in gallbladder wall thickness, total protein, albumin, prealbumin, total bilirubin, direct bilirubin, indirect bilirubin, glutamic oxaloacetic transaminase and total bile acid between the two groups without ascites. There is no obvious correlation between residual index and guarantee thickness. There were significant differences in gallbladder wall thickness, total protein and albumin between the two groups with or without "bilateral" sign of gallbladder. The difference of gallbladder wall thickness between group C and group C was statistically significant. There was significant difference in the thickness of gallbladder wall between grade A and grade C patients. There was no statistical difference between the grade B and grade C of liver function. Whether the patients had ascites and whether there was a difference in the thickness of gallbladder wall between the two groups was statistically significant. The ROC curve was used to calculate the thickness of gallbladder wall, and the truncation value was 0.59 cm ~ (-1) 0.58 cm 路cm. The ROC curve was made for grade A and B ~ C of liver function grade. The truncation value was 0.62cm.Conclusion Ultrasound measurement of gallbladder wall thickness in patients with hepatitis B cirrhosis is a simple, safe and non-invasive method. It has important clinical value for the evaluation of liver function in patients with hepatitis B cirrhosis. It is significant for clinicians to judge the condition of patients with liver cirrhosis. The follow-up of patients with cirrhosis in addition to routine examination has a clear focus, so that ultrasound examination and clinicians to the requirements of the examination closely combined. The significance can understand more intuitively the influence of the complications of liver cirrhosis on the body, and actively cooperate with doctors to control the disease.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R512.62;R575.2;R445.1

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